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Review
. 2022 May;49(3):315-337.
doi: 10.1017/cjn.2021.127. Epub 2021 Jun 18.

Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020

David J Gladstone  1 , M Patrice Lindsay  2 , James Douketis  3 , Eric E Smith  4 , Dar Dowlatshahi  5 , Theodore Wein  6 , Aline Bourgoin  7 , Jafna Cox  8 , John B Falconer  9 , Brett R Graham  10 , Marilyn Labrie  11 , Lena McDonald  12 , Jennifer Mandzia  13 , Daniel Ngui  14 , Paul Pageau  15 , Amanda Rodgerson  16 , William Semchuk  17 , Tammy Tebbutt  18 , Carmen Tuchak  19 , Stephen van Gaal  20 , Karina Villaluna  21 , Norine Foley  22 , Shelagh Coutts  4 , Anita Mountain  23 , Gord Gubitz  24 , Jacob A Udell  25 , Rebecca McGuff  2 , Manraj K S Heran  26 , Pascale Lavoie  27 , Alexandre Y Poppe  28 ; Canadian Stroke Consortium
Affiliations
Review

Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020

David J Gladstone et al. Can J Neurol Sci. 2022 May.

Erratum in

  • Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020 - ADDENDUM.
    Gladstone DJ, Patrice Lindsay M, Douketis J, Smith EE, Dowlatshahi D, Wein T, Bourgoin A, Cox J, Falconer JB, Graham BR, Labrie M, McDonald L, Mandzia J, Ngui D, Pageau P, Rodgerson A, Semchuk W, Tebbutt T, Tuchak C, van Gaal S, Villaluna K, Foley N, Coutts S, Mountain A, Gubitz G, Udell JA, McGuff R, Heran MKS, Lavoie P, Poppe AY; Canadian Stroke Best Practice Recommendations Advisory Committee, in collaboration with the Canadian Stroke Consortium. Gladstone DJ, et al. Can J Neurol Sci. 2023 May;50(3):481. doi: 10.1017/cjn.2022.57. Epub 2022 Jun 3. Can J Neurol Sci. 2023. PMID: 35657682 No abstract available.

Abstract

The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute transient ischemic attack (TIA) and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; low-density lipoprotein lowering; hypertriglyceridemia; diabetes treatment; and patent foramen ovale management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. In addition, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

Keywords: Guidelines; Management; Risk assessment; Secondary prevention; Stroke; Transient ischemic attack.

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